Original article doi:10.1111/j.1463-1318.2012.02943.x ALEXIS O-Ring wound retractor vs conventional wound protection for the prevention of surgical site infections in colorectal resections 1 K. P. Cheng*, A. C. Roslani*, N. Sehha†, J. H. Kueh*, C. W. Law*, H. Y. Chong* and K. Arumugam‡ *Department of Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia, †Ambulatory and Wound Care Unit, University of Malaya Medical Centre, Kuala Lumpur, Malaysia and ‡Biostatistics Department, University of Malaya, Kuala Lumpur, Malaysia Received 13 September 2011; accepted 5 December 2011; Accepted Article online 23 January 2012 Abstract Aim Surgical site infection (SSI) remains a common postoperative morbidity, particularly in colorectal resec- tions, and poses a significant financial burden to the healthcare system. The omission of mechanical bowel preparation, as is performed in enhanced recovery after surgery programmes, appears to further increase the incidence. Various wound protection methods have been devised to reduce the incidence of SSIs. However, there are few randomized controlled trials assessing their efficacy. The aim of this study is to investigate whether ALEXIS wound retractors with reinforced O-rings are superior to conventional wound protection methods in preventing SSIs in colorectal resections. Methodology Patients undergoing elective open colo- rectal resections via a standardized midline laparotomy were prospectively randomized to either ALEXIS or conventional wound protection in a double-blinded manner. A sample size of 30 in each arm was determined to detect a reduction of SSI from 20% to 1% with a power of 80%. Secondary outcomes included postoperative pain. The operative wound was inspected daily by a specialist wound nurse during admission, and again 30 days post- operatively. Statistical analysis was performed using SPSS version 13 with P < 0.05 considered significant. Results Seventy-two patients were recruited into the study but eight were excluded. There were no SSIs in the ALEXIS study arm (n = 34) but six superficial incisional SSIs (20%) were diagnosed in the control arm (P = 0.006). Postoperative pain score analysis did not demonstrate any difference between the two groups (P = 0.664). Conclusion The ALEXIS wound retractor is more effective in preventing SSI in elective colorectal resections compared with conventional methods. Keywords Alexis, retractor, prevention, surgical site infection, colorectal What is new in this paper? This paper investigates the effectiveness of the updated ALEXIS wound retractors with reinforced O-rings in preventing surgical site infection in colorectal resections only. The control arm was standardized to abdominal packs wound protection and Balfour retraction which was not done in preceding studies. Introduction Surgical site infection (SSI) is a serious complication to abdominal surgery, causing increased morbidity. SSI can have a devastating impact on the patient’s course of treatment and is associated with increased treatment intensity, increased antibiotic usage, prolonged length of stay, higher costs and decreased quality of life. The SSI burden may be disproportionately high in countries with limited resources [1]. In spite of modern standards of preoperative prepara- tion, antibiotic prophylaxis and refinements in anaesthetic and operative techniques, postoperative wound infection remains a serious problem. More than 20% of hospital acquired infections are attributed to infection of a surgical site, only second to urinary tract infection, and are typically defined according to procedure and location of infection [2]. 1 Presented at the Malaysian College of Surgeons Annual Scientific Meeting, Kuching, Sarawak, Malaysia, 20–22 May 2011. (Ethicon Prize Young Investigator Winner). Correspondence to: Associate Professor Dr April Camilla Roslani, Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. E-mail: aprilroslani@hotmail.com Ó 2012 The Authors e346 Colorectal Disease Ó 2012 The Association of Coloproctology of Great Britain and Ireland. 14, e346–e351